Fertility after testicular cancer

The removal of one testicle will not affect a man’s ability to father children. However, chemotherapy usually causes infertility during and for a time after treatment, and for some men this may be permanent. For this reason men are usually advised to store sperm before starting chemotherapy treatment.

Men, who live quite close to the hospital, may be able to produce sperm samples at home. Otherwise samples are produced at the hospital. Some hospitals store sperm free, but if the hospital has to pay for this service, the patient may be charged.

Explains that sperm samples can be produced at home if you live near the hospital.

Age at interview 43

Gender Male

Age at diagnosis 26

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You mentioned sperm, did they offer you sperm storage?

Yeah this is it as well, yeah going to that, I’m glad you asked that. When they told me I had to have chemotherapy to hopefully kill the tumour that was left in me they did mentioned my sperm count saying because I had, actually hadn’t had any children at that point. I didn’t plan having any children, but in case I did they did offer me a chance of banking some sperm should the need arise. Because sometimes they say that the chemotherapy can kill, can ruin your sperm count and it won’t come back. So consequently if they have banked some sperm you’ve got some in there for the future should you need it. I was told to go along, I spoke to the person on the phone. In this hospital I, you know I’ve seen sort of comedy sketches or whatever about the sperm bank where you go into a room with men’s book or magazine or whatever and give a sample let’s say. It wasn’t like that and in fact the person on the phone said if you can do a sample at home and I got a tube from my, a little specimen tube from my GP’s surgery, was if I could it at home I can’t remember the time span but you’ve got like a couple of hours to bring it in to the hospital. Now I lived about 20 miles away so I actually drove most of the way in, then got a tube in which was quite an experience. You’re standing on a crowded tube with a tube of, you know tube train with a specimen of sperm in your pocket. So you think I hope no one crushes it. But I got in there, handed it over and then waited for the result, which would go then to my GP.

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Explains how he banked some sperm in case he wanted children in the future.

Age at interview 24

Gender Male

Age at diagnosis 22

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And I haven’t got a family, I’m not married or anything and like I would like kids one day and so they said because the chemotherapy can affect all the cells in your body it’s best to have well made sperm now just in case the sperm producing cells are damaged by the chemo and all the sperm in future, you’re left infertile. So they can ask you to bank some sperm. And you go up to the hospital and you talk to a very nice man about all your options. And they kind of send you into this little tiny room with theres a stash of provocative material and leave you there for 10 minutes to do your thing. And then they come back and you give them your little pot and you carry on your way. And that’s like, it’s just a bizarre thing to do. But again they’ve done it 1,000 times and they have men coming in doing it the whole time. And yeah and they kind of, they take, they have a quick look to see how many sperm you have and whether they’re good quality and they store them in little tubes. So I produced 8 tubes and they always talk about how many tubes you’ve got in the liquid nitrogen I think it is and then I’m just waiting for IVF treatment. The thing is you can never been sure whether the sperm you’ve got after the chemo are going to be of good enough quality to actually you know lead to fertilisation. So probably if I do ever try for children it will be with the sperm that I’ve got stored up at the hospital. And I’ve got enough there, yeah 8 tubes is kind of 8 cycles of IVF so I get 8 bashes at having kids later on. But I have to pay, they give you the first year free and after that it’s 50 a year to keep them stored which is nothing when it’s like your children pretty much.

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Radiotherapy does not usually cause infertility either, but sperm banking should be offered before treatment starts. One man was worried because he wasn’t offered sperm banking before radiotherapy, and was relieved when his wife subsequently had a baby girl. Another man mentioned that the doctor wrongly assumed that because he had two children he didn’t need to consider sperm banking before his radiotherapy.

Recalls his concern when wasn’t offered sperm storage before radiotherapy, and relief he felt…

Age at interview 36

Gender Male

Age at diagnosis 33

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It’s uncomfortable but long term hasn’t been a problem at all. And even in terms of, one thing which was concerning us is the question of fertility, and a lot of the literature you read talks about perhaps storing some sperm before you have any treatment done. That option wasn’t actually given to me at all because the consultant felt that it wasn’t necessary and that was a bit worrying in the back of my mind for some time after that that perhaps there could have been some sort of side-effect. I think sometimes the radiotherapy can have the effect of reducing fertility or destroying it altogether. So that was a bit worrying for myself and my wife because we had planned to have another child.

Mm but you did ask the consultant about it, did you?

Yes I asked him on a number of occasions and he was fairly confident that, I mean he couldn’t guarantee it 100% but he was fairly confident that it wouldn’t be a problem. And it turned out not to be a problem in the end because I was actually, we had a young daughter 7 weeks ago.

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Recalls that he wasn’t offered sperm banking because the doctor assumed that he had completed his…

Age at interview 46

Gender Male

Age at diagnosis 44

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Right well I went down that afternoon, I spent the day in bed there and people came and saw me and they were very jolly and asked me, got me some details and I remember one guy, a consultant I believe, or a registrar are they called when they’re on the ward, I’m not sure, but he went through his list of things he should be asking me and he mentioned fertility and said “Oh you’ve got 2 children haven’t you,” he said “so that won’t be a problem to you,” then passed on. And it was only later I realised that you know there is a point to that because you can bank sperm. I never realised but it wasn’t offered to me, probably because I was mid 40s and had 2 children already, which I think is a bit naughty but there you go.

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Some of the men interviewed here reported that their sperm wasn’t active before their operation to remove a testicle.

Reassures men that sex is just as good as it was before the operation to remove a testicle.

Age at interview 51

Gender Male

Age at diagnosis 46

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So is sex just the same?

Afterwards I mean, to be quite honest with you, I enjoyed it more [laughs]. But uh, no I mean theres no, I couldn’t find any difference at all with sex at all. There is none. I mean they did say to me they could freeze my sperm but seeing as it wasn’t active beforehand that would have made no difference to me, but for other people they can, they can freeze, freeze half a gallon of the stuff if you want about a thousand babies, I mean its up to them. But you literally, once you’ve had the op you don’t

So for you sex is just the same, you’ve had an erection just the same, you can ejaculate just the same?

Oh in fact I found I ejaculate more. It seems to produce more whatever it is it’s producing, but it seems to produce more.

That’s good.

Yeah, everything, literally everything in that quarter, none of its gone; it was just the same.

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One man described his distress at finding out that he was infertile before his chemotherapy started, and he was felt it was ‘out of order’ when the GP’s receptionist wrongly assumed that he would be pleased that his sperm count was nil, thus avoiding the need for contraceptives. It is known that successful treatment with chemotherapy may actually cause sperm production to improve. This man was delighted that his sperm count returned to normal some time after his treatment had finished, thus giving him the choice of having children in future.

Says that he is pleased that his sperm count has returned to normal.

Age at interview 43

Gender Male

Age at diagnosis 26

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But they, they got back to me, I can’t remember how they got back to me but they said that apparently on freezing they lose 10% anyway and I didn’t have enough sperm in the sample to warrant freezing because really thered be none, no point in doing it.

Oh dear.

Which was rather a blow to me, as I say although I didn’t want any kids at that point it was something, that was a moment that I can remember that I really felt like I’d been hit with a hammer. It was like someone had taken away my choice. And whether that was a masculine thing or not I can’t really say, possibly you know people would say that, but I just felt my choice was taken and I felt gutted.

I was having a yearly test, via my GP, in the local hospital where I did a sperm sample and they tested it. And I remember one thing, now bearing in mind I might have been looking to have a good sperm count, I remember one day I phoned up and the receptionist at my GP’s surgery said “Okay yes, it’s alright you know your sperm count is still nil.” Now whether, if I was actually looking to have a sperm count that wouldve been a knock back but I mean at that point it was quite good for contraceptive purposes that I didn’t need it. But I just felt she was

out of order to actually assume something there.

But it’s all back to normal now and it has been so if I wanted kids I couldve had them or could have them you know. But in some cases apparently it doesn’t come back and the chemotherapy can kill it off.

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Sometimes surgery to remove a tumour or the lymph glands in the abdomen causes damage to the nerves that control ejaculation (see ‘Sex’). In this case sperm can be stored before surgery so that it is possible to father a child by assisted reproduction.

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